[ Prev ]
[ Next ]
Harry is a 47 year old male employed as an Adaptive Physical Education Teacher.
During class, while sitting on a bench in the school gym, Mr. H observed
an autistic child, with tendencies toward uncontrollable physical behavior,
running across the room.
When he realized this child was out of control, he held out his right
arm to catch the child as he ran by him.
As he caught him, Mr. H’s torso twisted to the right and he immediately
felt a sharp pain across his low back, left worse than right.
my initial history intake, I learned he was an avid body builder and, for a few
years, had been a “power lifter.”
Harry had terrible difficulty rising from or sitting down in a chair and
was barely able to get on the treatment table without assistance.
He stated that his typical pain level was 7/10 and he experienced this
pain no matter what activity he was doing or not doing.
He had been diagnosed with a herniated disc at L4-5 several years before
and he feared he had re-injured himself.
He had not had surgery for this problem and feared he may need that now.
performing several ROM tests for the lower half of the body, I was surprised to
find most of those tests within normal limits.
For someone in as much pain as Harry, his ROM for most tests was either
well within limits or better.
At this point, although his pain complaint was his low back, I asked him
to perform a simple test for the mouth opening.
A normal interincisal opening should accommodate 3 knuckles of the
His was nearly 3 1/2.
I, also, observed his ability to hyperextend his elbows.
two tests showed that hypermobility was part of the problem.
In the presence of hypermobility, ROM testing can often be misleading.
When the joints are considerably “lax”, muscles must work harder to
This extra effort is a considerable factor in the perpetuation of pain
following muscle trauma.
all the tests I had Harry perform that day, only one proved to be clearly
The hip extension test for the iliopsoas is performed with the patient
supine and one knee held to the chest.
The opposite thigh and leg are extended and a measurement taken between
the horizontal surface and the popliteal fold. Harry was positive by a width of
approximately 16 centimeters on the left and 12 centimeters on the right.
result would be 0, bilaterally.
psoas muscle attaches to the anterior lumbar spine, attaching not only to the
vertebral bodies but also to the discs.
It then travels caudally through the “well” of the pelvis, joining
the tendon of the iliacus as it inserts at the lesser trochanter.
It is the primary hip flexor.
almost every case treated by this therapist, when there is low back pain and a
history of disc bulge or herniation, the psoas is found to be not only
hypertonic, but frequently found to be disproportionately more shortened on one
side than the other. We find that
as the shorter psoas muscle pulls the lumbar spine into increased lordosis, it
also rotates it to the ipsilateral side.
in turn narrows the intervertebral space on the side of the shorter psoas, while
allowing the psoas on the opposite side to pull on the discs where the space
between the vertebral bodies is greater. This
can contribute to a disc bulge and/or herniation.
I believe this was the case with Harry.
used Myofascial Trigger Point Therapy and soft tissue mobilization in
conjunction with other techniques to release the psoas muscle. As a result,
Harry experienced a dramatic decrease in his pain by the second treatment.
After releasing the psoas, quadratus lumborum, lateral aspect of the
obliques, lumbar paraspinals and the latissimus dorsi, I was able to mobilize
his lumbar spine. Harry was able to
get off the treatment table with almost no pain, as well as sit and rise from a
chair without hesitation. He
reported his pain level as a 1-2/10.
Needless to say, we were both delighted with the outcome.
Harry began to increasingly engage in normal activities, there were minor
exacerbations of his pain to a level of approximately 3-4/10.
He was usually able to control the pain with his home exercise program,
which included a specific stretch for the psoas muscle.
After considerable modification of Harry’s workout routine at the gym,
he is now pain free and does not require the surgery that he so dreaded.
Prev ] [ Next ]